BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

We developed nomograms to predict disease recurrence in patients with Ta, T1 transitional cell carcinoma of the bladder. Thirty-eight training hospitals participated in this retrospective multicenter study. Between 1998 and 2002, a total of 1,587 patients with newly diagnosed non-muscle invasive bladder cancer were enrolled in this study. Patients with prior histories of bladder cancer, non-transitional cell carcinoma, or a follow-up duration of less than 12 months were excluded. With univariate and multivariate logistic regression analyses, we constructed nomograms to predict disease recurrence, and internal validation was performed using statistical techniques. Three-year and five-year recurrence-free rates were 64.3% and 55.3%, respectively. Multivariate analysis revealed that age (hazard ratio [HR]=1.437, p<0.001), tumor size (HR=1.328, p=0.001), multiplicity (HR=1.505, p<0.001), tumor grade (HR=1.347, p=0.007), concomitant carcinoma in situ (HR=1.611, p=0.007), and intravesical therapy (HR=0.681, p<0.001) were independent predictors for disease recurrence. Based on these prognostic factors, nomograms for the prediction of disease recurrence were developed. These nomograms can be used to predict the probability of disease recurrence in patients with newly diagnosed Ta, T1 transitional cell carcinoma of the bladder. They may be useful for patient counseling, clinical trial design, and patient follow-up planning.
Aged ; Carcinoma in Situ/diagnosis/epidemiology ; Carcinoma, Transitional Cell/*diagnosis/*epidemiology ; Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; *Nomograms ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Recurrence ; Regression Analysis ; Reproducibility of Results ; Urinary Bladder Neoplasms/*diagnosis/*epidemiology

PURPOSE: This study was conducted to evaluate the patterns of disease progression following either resection or palliative management of hilar cholangiocarcinoma and to clarify the polarity of the resection margin. METHODS: The medical records of 78 hilar cholangiocarcinoma patients who were admitted to the Inha University Hospital between June of 1996 and May of 2006 were retrospectively reviewed. The patterns of recurrence were compared between the margin positive, margin negative and palliative management groups, and factors influencing recurrence and survival were then analyzed using the Cox proportional hazard model. RESULTS: The hilar cholangiocarcinoma recurred or progressed in 56 patients (71.8%) following the initial treatment, and the median progression free survival (PFS) time was 10.1 months. The 3-yr estimates of overall relapse and the median PFS were 90.7% and 17 months, respectively, in the resection group (n=32) and 100% and 7 months, respectively, in the palliative group (n=46) (p=0.045). There was no significant difference observed in the 3-yr estimates of overall disease progression or the median PFS according to the margin positivity or resection methods. When the disease progression pattern was analyzed, there was no significant difference observed between the groups, however, the survival analysis showed that survival was greater in the group that underwent resection with curative intent than in the palliative management group (p=0.001). Adjuvant chemotherapy or radiotherapy had no effect on recurrence or survival, and poor differentiation was the only significant prognostic factor for survival identified when the Cox proportional hazard model was used. CONCLUSION: Because no difference in the pattern of disease progression existed, aggressive surgical resection should be attempted to prevent recurrence and to increase survival, even in cases in which a suspicious positive resection margin is present.
Chemotherapy, Adjuvant ; Cholangiocarcinoma* ; Disease Progression ; Disease-Free Survival ; Humans ; Medical Records ; Proportional Hazards Models ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND: Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. MATERIALS AND METHODS: The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. RESULTS: The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. CONCLUSION: As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health.
Communicable Diseases* ; Female ; Hand ; Hepatitis B ; HIV ; HIV Infections ; Humans ; Inpatients ; Liver Diseases ; Lymph Nodes ; Male ; Mass Screening ; Medical Staff ; Prevalence* ; Public Health ; Syphilis ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. MATERIALS AND METHODS: The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. RESULTS: The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. CONCLUSION: As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health.
Communicable Diseases* ; Female ; Hand ; Hepatitis B ; HIV ; HIV Infections ; Humans ; Inpatients ; Liver Diseases ; Lymph Nodes ; Male ; Mass Screening ; Medical Staff ; Prevalence* ; Public Health ; Syphilis ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

Purpose: This multiinstitutional study was to investigate the accuracy of the Kattan nomograms for the prediction of recurrence after definitive surgery for renal cell carcinoma (RCC) in Korean patients and develop a nomogram revised to complement the shortcomings. Materials and Methods: Clinical and pathological data of 1,866 patients with RCC who had been followed for at least 2 years after surgery in each participating institutes were reviewed as well as evidence of disease recurrence, defined to include local recurrence and distant metastasis. Accuracy of the Kattan nomograms' predictability in tumors 7cm or less was tested by calculating the area under the receiver-operating characteristics curve (AUC) and actuarial recurrence-free survival by Kaplan- Meier method. We used the Cox proportional hazard analysis to identify significant variables and develop prediction nomogram, and internally validated by bootstrapping method. Mean follow-up was 56.5 months (24-184). Results: Recurrence occurred in 12.5% of the patients and correlated with the pathological stage, with 4.3%, 7.9%, 15.0%, 22.6%, 38.4%, 58.3% for stages T1a, T1b, T2, T3a, T3b/c and T4, respectively (p<0.001). The AUC of the Kattan nomograms was 0.276. Factors significantly predictive of recurrence were T stage (p<0.0001), presentation (p=0.006), preoperative hemoglobin (p=0.023) and gender (p=0.032). Actuarial 60-month recurrence- free survival was 87.9% and using the prognostic factors, nomogram predicting 60-month recurrence-free survival was constructed. Conclusions: Korean nomogram complementing the preexisting nomograms for the prediction of recurrence-free survival after definitive surgery for RCC has been constructed, which may be useful in patient prognostication, counseling and follow-up planning.
Academies and Institutes ; Area Under Curve ; Carcinoma, Renal Cell* ; Complement System Proteins ; Counseling ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; Neoplasm Metastasis ; Nomograms* ; Recurrence

Kidney transplantation is a ideal renal replacement therapy in the patient with end stage renal disease. It made improvement of the patients' life quality but made increase of the incidence of chances of malignant diseases of them. We report a 44-year-old male kidney recipient recently diagnosed as early gastric cancer, had diagnosed previously as malignant lymphoma 6 years ago. He received a kidney from his mother 13 years ago, and then 7 years later he was diagnosed as malignant lymphoma presented as 2.5 cm-sized solitary lung mass. Histologically, it was confirmed as diffuse large cell type lymphoma. After 2-year scheduled chemotherapy and radiation therapy, he achieved complete remission. He was diagnosed as early gastric cancer by routine Upper Gastro-Intestinal Series study. Histologically, it was defined as moderately differentiated adenocarcinoma. He underwent a subtotal gastrectomy (Billoth-II). After the operation, he preserved good graft function with no recurrence of malignancy until now. Briefing our case, a kidney recipient has been serially diagnosed different two kinds of malignancy, malignant lymphoma and early gastric cancer with interval of 7 years. He showed good responses to therapy of malignancies and excellent prognosis. We recommend specific schedule of regular malignancy screening test for kidney recipients with long duration of post-transplantation.
Adenocarcinoma ; Adult ; Appointments and Schedules ; Drug Therapy ; Gastrectomy ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Lung ; Lymphoma ; Male ; Mass Screening ; Mothers ; Prognosis ; Quality of Life ; Recurrence ; Renal Replacement Therapy ; Stomach Neoplasms ; Transplants

Primary squamous cell carcinomas of the renal pelvis and ureter are rare tumors, accounting for less than 1% of all primary tumors of the upper urinary tract. The ratio of renal pelvis to ureter tumors is approximately 6:1. The pathogenesis is assumed to begin with an urothelial metaplasia, as a result of a reaction to chronic irritation and infection, which lead to dysplasia, and ultimately to a squamous cell carcinoma. Only one case of a squamous cell carcinoma of the ureter has been reported in the Korean literature. We report a case of a primary squamous cell carcinoma of the ureter, as a result of a reaction to chronic irritation and infection in a 48-year-old male patient.
Carcinoma, Squamous Cell* ; Humans ; Kidney Pelvis ; Male ; Metaplasia ; Middle Aged ; Ureter* ; Urinary Tract

BACKGROUND: Preeclampsia, pregnancy induced hypertension, is considered to be associated with increased vascular permeability leading to albumin loss from the intravascular space. Although hypoalbuminemia is common in pregnant women with preeclampsia, the impact of hypoalbuminemia on maternal and fetal morbidity in preeclampsia is not well known yet. METHODS: This study included 392 pregnant women with preeclampsia. The patients were divided into hypoalbuminemia group (serum albumin <3.0 g/dL) and normal group (serum albumin >or=3.0 g/dL) based on the lowest serum albumin level. And we compared clinical factors representing maternal and fetal morbidity between the two groups. The mean age of the patients was 30+/-5 years and mean pregnant duration was 35.5+/-3.4 weeks. RESULTS: Of the total 392 patents, 280 patients (71.4%) had hypoalbuminemia. Compared to normal group (n=112), hypoalbuminemia group (n=280) had higher incidence of twin pregnancy (7.5% vs. 1.8%, p=0.030), acute renal failure (12.5% vs. 3.6%, p=0.008), hepatic dysfunction (33.5% vs. 12.2%, p<0.001), thrombocytopenia (37.8% vs. 19.6%, p=0.001), severe proteinuria (>3.5 g/day) (34.4% vs. 10.8%, p=0.002), respectively. But there was no difference in maternal age, pulmonary edema, abruptio placenta, postpartum hemorrhage between the two groups. Concerning fetal morbidity, the incidence of intrauterine growth retardation in hypoalbuminemia group was higher than that in normal group (25.0% vs. 12.5%, p=0.011) and birth weight in hypoalbuminemia group was smaller than that in normal group (2.5+/-0.8 vs. 2.8+/-0.8 kg, p=0.002). CONCLUSION: This data suggest that hypoalbuminemia frequently occurs in pregnant women with preeclampsia and it is closely associated with maternal and fetal morbidity.
Acute Kidney Injury ; Birth Weight ; Capillary Permeability ; Female ; Fetal Growth Retardation ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Hypoalbuminemia ; Incidence ; Maternal Age ; Placenta ; Postpartum Hemorrhage ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pregnant Women ; Proteinuria ; Pulmonary Edema ; Serum Albumin* ; Thrombocytopenia